OBJECTIVETo investigate the effect of propofol on brain regions at different sedation levels and the association between changes in brain region activity and loss of consciousness using blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) and bispectral index (BIS) monitoring.

METHODSForty-eight participants were enrolled at Peking Union Medical College Hospital from October 2011 to March 2012 and randomly assigned to a mild or a deep sedation group using computer- generated random numbers. Preliminary tests were performed a week prior to scanning to determine target effect site concentrations based on BIS and concomitant Observer's Assessment of Alertness/Sedation scores while under propofol. Within one week of the preliminary tests where propofol dose-response was established, BOLD-fMRI was conducted to examine brain activation with the subject awake, and with propofol infusion at the sedation level.

RESULTSMild propofol sedation inhibited left inferior parietal lobe activation. Deep sedation inhibited activation of the left insula, left superior temporal gyrus, and right middle temporal gyrus. Compared with mild sedation, deep propofol sedation inhibited activation of the left thalamus, precentral gyrus, anterior cingulate, and right basal nuclei.

CONCLUSIONMild and deep propofol sedation are associated with inhibition of different brain regions, possibly explaining differences in the respective loss of consciousness processes.

Adult ; Brain ; drug effects ; Consciousness Monitors ; Deep Sedation ; Dose-Response Relationship, Drug ; Humans ; Hypnotics and Sedatives ; pharmacology ; Male ; Propofol ; pharmacology

OBJECTIVETo study the psychedelic effects in healthy volunteers when given subanesthetic dose of ketamine.

METHODSThirteen male healthy volunteers aged 24-39 years were enrolled. All subjects received subanesthetic doses of ketamine using target control infusion. A stepwise series of target plasma concentrations (0, 100, 200, and 300 ng/ml) were maintained for 20 minutes each. Visual analogue scale (VAS) of mechanical pain by von Frey hair was evaluated, and then the volunteers completed a VAS rating of 13 symptom scales. Pictures were shown to them at the same time. Heart rate, mean blood pressure, and SpO2 were monitored throughout the infusion.

RESULTSDuring the process of analgesia, ketamine produced dose-related analgesic effects. With the increase of ketamine dose, some psychedelic effects became more obvious and the memory impairment became worse stepwisely.

CONCLUSIONTarget control infusion of subanesthetic doses of ketamine produce obvious psychedelic effects in healthy volunteers.

Adult ; Anesthetics, Dissociative ; administration & dosage ; adverse effects ; pharmacology ; Dose-Response Relationship, Drug ; Hallucinations ; chemically induced ; Humans ; Ketamine ; administration & dosage ; adverse effects ; pharmacology ; Male

This study investigated the effect of puerarin on human umbilical vein endothelial cells (HUVEC) injured with hydrogen peroxide (H₂O₂). HUVEC were divided into three groups: a control group, a model group (H₂O₂ 400 μmol·L^-1) and a puerarin-treated group (3, 10, 30 and 100 μmol·L^-1). HUVEC were cultured with varied concentration of puerarin for 2 h and treated with H₂O₂ for another 24 h. Cell proliferation was detected by a CCK-8 assay. The mitochondrial membrane potential was measured by a JC-1 fluorescent probe. A transwell chamber assay was adopted to observe cell migration ability. Mitochondrial respiratory function was measured in a two-chamber titration injection respirometer (Oxygraph-2k). The expression of interleukin-1β (IL-1β), interleukin-18 (IL-18) and tumor necrosis factor-α (TNF-α) was detected by quantitative real-time PCR. The expression of pyroptosis-mediated proteins, including cleaved-cysteinyl aspartate-specific proteinase-1 (caspase-1), N-gasdermin D (N-GSDMD), NOD-like receptor protein 3 (NLRP3) and purinergic ligand-gated ion channel 7 receptor (P2X7R) was detected by Western blot. The results show that 400 μmol·L^-1 H₂O₂ treatment for 24 h causes obvious damage to HUVEC. Compared with the model group, puerarin protected against cellular injury in a dose-dependent manner, with the greatest effect at a dose of 30 and 100 μmol·L^-1. Puerarin significantly decreased the mitochondrial membrane potential and improved mitochondrial function. Puerarin inhibited cell migration induced by H₂O₂, suppressed the expression of IL-1β, IL-18 and TNF-α, and down-regulated the pyroptosis-mediated protein. These changes are statistically significant (P < 0.05). These findings demonstrate that puerarin has a protective effect against H₂O₂-induced oxidative damage of HUVEC by inhibiting the migration of HUVEC cells. The mechanism may be related to improved mitochondrial respiratory function and inhibition of pyroptosis.

OBJECTIVETo compare the accuracies of cerebral state index (CSI) and bispectral index (BIS) in sedation monitoring during target control infusion of midazolam.

METHODSTwenty informed adult male volunteers were intravenously administered with midazolam through plasma target control infusion from 30ng/ml (in increments of 10ng/ml every time) until they became unresponsive to tactile stimulation (i. e., mild prodding or shaking). The BIS and CSI were continuously recorded simultaneously. Sedation was assessed using the Observers' Assessment of Alertness/Sedation (OAA/S) scale at each time when Ct equaled to Ce. The electroencephalogram (EEG) parameters were correlated with the OAA/S scores using nonparametric Spearman's correlation analysis. The prediction probabilities were calculated at the points of lost of verbal contact (LVC) and lost of responses to stimulus (LOR). BIS05, BIS50, BIS95, and CSI05, CSI50, CSI95 were also calculated for LVC and LOR.

RESULTSBIS and CSI were well correlation with OAA/S scales during both the onset and recovery phases. When the sedation level increased, BIS and CSI progressively decreased. The prediction probabilities of BIS and CSI were 84%, 74% for LVC and 79%, 68% for LOR, while the BIS05, BIS50, and BIS95 as well as CSI05, CSI50, and CSI95 were 85.5, 60.6, and 35.7 (for BISs) and 82.2, 65.2, and 30.3 (for CSIs) at the point of LVC and 79.7, 47.6, and 15.6 (for BISs) and 75.9, 43.4, and 11 (for CSIs) at the point of LOR.

CONCLUSIONSBoth CSI and BIS seem to be useful parameters for assessing midazolam-induced sedation. BIS is superior in the prediction of LVC and LOR.

Adult ; Anesthetics, Intravenous ; administration & dosage ; therapeutic use ; Brain ; drug effects ; physiology ; Conscious Sedation ; methods ; Consciousness ; drug effects ; Electroencephalography ; Humans ; Infusions, Intravenous ; Male ; Midazolam ; administration & dosage ; therapeutic use ; Young Adult

This study aimed to evaluate the vasorelaxant effect and mechanisms of compound reserpine and triamterene tablets (CRTTs) and its component triamterene on isolated rat thoracic aorta rings. Isolated rat thoracic aorta rings pre-contracted by high potassium or norepinephrine (NE) were used to evaluate the vasodilatory effect of CRTTs and its component triamterene. The mechanisms concerning endothelium, potassium channels and calcium channels were studied through the interventions of several tool drugs. Animal welfare and experimental procedures followed the requirements of the Laboratory Animal Management and Animal Welfare Ethics Committee of the Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College. The results showed that both CRTTs and triamterene had potent relaxant effect on KCl and NE pre-contracted vessels. Triamterene showed partial endothelium dependency, and N-nitro-L-argininemethyl ester hydrochloride (L-NAME) could influence the relaxant effect, which may be related to the opening of calcium-activated potassium channels. Meanwhile, CRTTs could inhibit intracellular Ca²⁺ release and extracellular Ca²⁺ influx. Overall, CRTTs and its component triamterene have vasorelaxant effects on vessels in vitro, and the vasorelaxant effect of CRTTs may be related to intracellular Ca²⁺ release and extracellular Ca²⁺ influx, while this effect of triamterene may depend on vascular endothelial function and may also be related to the opening of calcium-activated potassium channels.

OBJECTIVETo improve the surgery results and living quality of patients following the operation of the combined approach of tympanoplasty and mastoidectomy with close technique.

METHODSThe clinical data and following-up results of 49 patients treated with combined approach of tympanoplasty and mastoidectomy with close technique and 82 patients treated with open mastoidectomy with tympanoplasty were retrospective analyzed.

RESULTSIn the group treated with combined approach tympanoplasty, all patients got dry ear in 20 days and 31 patients' hearing level enhanced over 15 dB after the operation; but in the group treated with open mastoidectomy with tympanoplasty, only 13 patients got dry ear in 20 days and no patients' hearing level enhance over 15 dB after the operation. Although the recurrence rates between two groups were not significant difference, the patients of former group not only took a shorter recovery time and got a better hearing recovery, but also kept a normal external auditory meatus, at the same time, they need not to clear scab at fixed period all life long.

CONCLUSIONSWhen performed on carefully selected patients, combined approach tympanoplasty was a feasible surgical method to improve the surgery results and living quality of patients following the operation, however, the advanced equipment and perfect operation skill are necessary.

Adolescent ; Adult ; Cholesteatoma, Middle Ear ; surgery ; Female ; Humans ; Male ; Mastoid ; surgery ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Tympanoplasty ; methods ; Young Adult

Objective To study the effect of propofol intravenous on myocardial damage degree and cardiac function for 2 diabetes patients before and after coronary artery bypass grafting.Methods Seventy-six patients with type 2 diabetes in our hospital was selected from April 2014 to October 2015.The patients were divided into treatment group and control group,according to the method of random numbers,38 cases in each group.Patients in two groups were taken general anesthesia induction,treatment group were infused 1-2 μg · kg-1 · mL-1 propofol after anesthesia induction to maintain anesthesia,continuous intravenous infusion of 0.2-0.4 μg · kg-1 · min-1 fentanyl.Patients in control group isoflurane inhalation and intravenous 0.2-0.4 μg · kg-1 · min-1 fentanyl.Before surgery and postoperative 12 h,the level of the malondialdehyde (MDA),superoxide dismutase (SOD),ischemia modified albumin (IMA),troponin I (cardiac troponin I,cTnI) in two groups were measured by spectrophotometer.Results Before the operation,the level of MDA,SOD,IMA,cTnI in the treatment group were (3.69 ±0.43) nmol · L-1,(73.24 ±6.13) nmol · L-1,(77.29 ± 3.94)ABSU · mL-1,(0.08 ± 0.02) μg · L-1,respectively while in control group were (3.62 ± 0.37) nmol · L-1,(72.36 ±8.22)nmol · L-1,(77.61 ± 3.74) ABSU · mL-1,(0.07 ± 0.01) μg · L-1 with no significant difference (P＞0.05).After 12 h of operation,the level of MDA,IMA,cTnI in treatment group were (4.42 ±0.82) nmol · L-1,(70.52 ± 2.62) ABSU · mL-1,(3.70 ± 0.28) μg · L-1,significantly lower than control group with (7.14 ±1.01)nmol · L-1,(73.63 ±4.12) ABSU · mL-1,(4.79 ±0.29)μg · L-1.But SOD in treatment group was (68.74 ± 6.82) nmol · L-1,significantly higher than the control group with (64.O1 ± 5.88) nmol · L-1,the difference between two groups above factors had statistical significance (all P ＜ 0.05).Conclusion Patients with type 2 diabetes using CABG surgery,the use of intravenous propofol,compared with isoflurane,can effectively reduce the degree of myocardial injury and effectively protect the cardiac function in patients.

Objective To develop a rating scale assessing the nursing outcomes of geriatrics with chronic disease,in order to provide valid evaluation tools for health assessment of geriatrics with chronic disease during hospitalization and after discharge.Methods Based on literature reviews,the rating scale was preliminarily developed.Through twice expert consultation,the scale was revised.The validity and reliability of the rating scale was evaluated by 3 clinical nurse specialists through investigation of 187 cases of discharged geriatrics with chronic diseases.Results The rating scale assessing the nursing outcomes of geriatrics with chronic disease included 4 aspects and 38 items:Functional Health (12 items),Physical Health (10 items),Psychosocial Health (5 items),Health Knowledge and Behavior (11 items).The results of scales evaluation showed that the rating scale had good construct validity,content validity and discrimination validity,and the Cronbach' s c of all domains were above 0.70,indicating a good internal consistency.Conclusions The results suggest that the rating scale has good rehability and validity,and can be used to assess the health status of domestic geriatrics with chronic diseases by specialists and researchers.

OBJECTIVETo discuss the clinical features and surgical treatments of giant coronary artery aneurysm (CAA).

METHODSFrom July 1996 to October 2004, 6 giant CAA patients were underwent surgery at Fuwai hospital. Three cases were underwent CAA resection, 2 concomitant coronary bypass, 3 reconstruction. The giant CAA was often combined with other cardiac diseases. Four cases underwent additional procedures of fistula closure, 3 aortic valve replacements, 2 aortoplasty and 1 thrombus cleaning at the same time.

RESULTSAll patients recovered uneventfully. The mean of cardiopulmonary bypass time was (144 +/- 26) min (range 67 to 207 min). Aortic cross clamping time was (104 +/- 21) min (range 56 to 172 min). Patients follow-up time occurred from 8 to 87 months (mean of 48 months). All patients were free of symptoms during follow-up. None of the patients died during the follow-up period and none of the CAA recurred.

CONCLUSIONSThe giant CAA is a serious cardiovascular disease, early diagnosis and surgical treatment are mandatory.

Adult ; Coronary Aneurysm ; pathology ; surgery ; Coronary Artery Bypass ; Coronary Vessels ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Surgical Procedures, Operative ; methods ; Treatment Outcome

Adolescent ; Adult ; Aged ; Child ; Endoscopy, Gastrointestinal ; methods ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; pathology ; Humans ; Male ; Middle Aged